So next week I am having my first appointment with my new endo. She works in the same clinic as the old one and is under the whole Joslin umbrella so I am pretty sure she is cut from the same cloth as my last one. I am just hoping this one actually cares about and for her patients. So to that end I am starting to formulate some interview questions for her. The way I look at it, I am hiring this person to be my endo. My insurance company will be paying her salary so why not treat it like a job interview. Here are a few of the questions I am thinking of asking, if you have any additional things you think I should ask, please comment back. 1. Do you only treat diabetic patients or do you treat other endocrine conditions ?
2. What % of your patients are adult type 1 ?
3. Do you have D or do you have any family members with D ?
4. At what blood sugar level would you consider your patient to be hypoglycemic ?
5. Have you ever yourself actually been on a "hypoglycemic excursion"? I just want to know if in medical school or any other controlled clinical environment endos actually experience what a hypo or hyperglycemic event feels like. Since they all seem to be absolutely frightened to death by them. And I like the word excursion, it sounds kind of like a vacation.
6. Would you support a low carb diet for your diabetic patients ?
7. Do you consider an A1C of less than 6.0 with minimal hypos better than an A1C of 6.5 to 7 with minimal hypos in your T1 patients ?
8. Why am I taking Lantus and Humalog ? What are the differences between them and other analog insulins ?
So that is my start, anyone want to add anything ?
I don't think that the answers to those sort of questions would be as informative as asking them what sort of advice they'd give you for certain situations. EG "DP has been raging lately, how do I fix it?" or "I am running high, up to 140 after lunch, what should I do?" or "I want to lose weight [peeks, ok, you look skinny in your pics, maybe this won't work but you could ask anyway and see what they say?] and keep my BG level, how do I do this." These sort of constant tactical problems and being able to provide satisfactory answers are the big challenges we face and, if the doc doesn't provide a satisfactory answer to those questions, it doesn't matter what percentage of their patients are T1.
The "hypoglycemic excursion" question is sort of loaded as while I appreciate it, I think that it's sort of illegal/ malpractice to just take insulin for test purposes like that so, even if a doctor who is appropriately adventurous tried it out, they may not answer due to the propriety of the question.
Thanks for the input AR, I can generally count on you to provide some perspective. I understand that most of my questions are somewhat loaded but from a purely selfish standpoint, I want to know how much experience this endo actually has with adult Type 1 patients, since we represent only a very small percentage of the whole D picture. My CDE is quite good at helping me fix problems as far as basal and bolus requirements go, I do not get DP so far so it is not an issue and I have recently gotten a G4 Dexcom system I can now see where my blood sugar is going and what happens to my blood sugar in response to various foods and exercise. I have lost about 22 pounds since I started carb counting in May so maintaining the weight loss would probably be a more useful question. The hypo excursion question I already know the response to, but I would really like to know what endos are so scared of, or what they have been taught in school that makes them think all D's turn in to babbling idiots when they have a hypo.
I think your question #2 is important, and assuming it's a decent %, as a followup I would ask if she develops individual plans based on the person. Maybe ask how a typical session goes (with adult T1), who does the most asking, what would she expect of you. Will she get to know what's important to you, or does she think the appointments are about what she thinks is important.
I assume your last question is really regarding Lantus vs Levemir for example, or Humalog vs Novolog, etc ? I wonder if a better way might be to ask about specific concerns you're having with your basal or bolus routines. Are you high/low after meals, have DP, etc. Or maybe a matter of cost ? Then ask if using a different brand/insulin or timing/dosage might help.
Several of your questions are general and she will likely answer 'it depends' ! Why not say specifically, that YOU do low carb, or YOU have/want A1C < 6. Ask her if she'll support you with that, or would she try to talk you out of it.
One question I have asked new endos is why they chose being a dr, and why an endo. Just me being curious, and they are usually surprised by it, and give interesting answers. It can be a nice 'ice-breaker'.
thanks for the input MegaMinx. I never assume anything with an endo, so I doubt that the % of adult T1 patients will be "decent" we just are not a large % of the adult D population. But it would be nice to know if she has some measure of experience with my type of D. The A1C question is one I posed to the CDE at the clinic. She had said aim for 6.5 because lower is not always better. I asked her for a scientific reference with a type 1 population that actually stated "lower is not better" with regard to A1C's. She eventually said, well they are your goals so I will support them but only if you can get your A1C down without the expense of hypos. As for the last question, I am not only interested in the lantus/levemir difference, but also the apidra, humalog, novolog differences. It seems as though my previous endo, just wrote the scripts and said, take this sliding scale, and I never really questioned him. I'm now ready to question everything. I don't specifically do low carb, but I have cut down dramatically and it has made a big difference in my control. The previous endo was just so crappy, I think I am more gun shy than anything else. But at the same time I am approaching menopause and I know D gets much harder to control so I would prefer to have an endo I not only trust but I respect as well. I'm hoping she will be but at the same time, I already have the name of an endo even closer who gets rave reviews from her patients, so we'll see. And heck my PCP got me my Dexcom system, so worst comes to worst I can always just see her and skip the endo altogether.
Over time, I have become more concerned about how my endo will respect "my choices" about "my diabetes." I wish to set my own goals and make choices about my treatment. If I refuse all cholesterol treament, I don't need to be tested every visit for cholesterol and I don't need to be berated about my choice. I don't want a doctor that simply dictates to me what they think I must do. I don't want a doctor who ignores my wishes and labels me "non-compliant."
And I also want a doctor who really listens. I have encountered many doctors who are not really good at listening. I know it sounds strange, but many doctors have blinders on, they only hear certain things and they only look at certain things.
I am fortunate to have found an endo who does both of these things well. My previous endo, while highly respected within his field for his competency, he totally failed to consider "my diabetes" and he really failed to listen.
Thanks Brian, I am lucky to have a PCP who is smart, listens well, and if she had a CDE in her office to help with the technical stuff I wouldn't even need an endo. But unfortunately she does not and I really like and respect the CDE at the Joslin clinic, so I will suffer the semi-annual endo visit just so I can have her on email. My previous endo is a "senior" doctor at the Joslin but he completely failed not only to listen but to care.
